title: Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database.
abstract: OBJECTIVE
  To determine the risk of coronary heart disease (CHD), acute myocardial infarction (MI), and CHD-related mortality in patients with panic attacks/disorder.
  
  
  RESULTS
  We conducted a cohort study using 650 practices in the 'General Practice Research Database'. We selected all 57 615 adults diagnosed with panic attacks/disorder and a random sample of 347 039 unexposed, frequency matched for sex/age, and measured incidence of CHD, MI, and CHD-related mortality rate. There was a significantly higher incidence of MI following new onset panic in people under 50 years of age, but not in older age groups. There was a higher incidence of CHD for all ages, more marked in those under 50 years, but no significant differences in CHD mortality. Fully adjusted models showed panic attacks/disorder were associated with a significantly increased hazard of MI in those under 50 years (HR 1.38, 95% CI 1.06-1.79) and CHD at all ages (<50 years, HR 1.44, 95% CI 1.25-1.65; > or =50 years, HR 1.11, 95% CI 1.03-1.20), but no increased hazard of MI over 50 years (HR 0.92, 95% CI 0.82-1.03), and a slightly reduced CHD-mortality at all ages (HR 0.76, 95% CI 0.66-0.88).
  
  
  CONCLUSIONS
  New onset panic attacks/disorder were associated with increased hazard of subsequent CHD/MI diagnosis in younger people, but with less effect in people over 50, and a slightly reduced hazard of CHD-related mortality. This may be due to initial misdiagnosis of CHD as panic attacks or an underlying increased risk of CHD with panic attacks/disorder in younger people.
authors.affiliation: Department of Primary Care & Population Sciences, Hampstead Campus, University College London, Rowland Hill St, London NW3 2PF, UK. k.walters@pcps.ucl.ac.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
authors.forename: Rachael
authors.initials: R
authors.lastname: Williams
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000523:psychology*; D016208:Databases, Factual; D003937:Diagnosis, Differential; D004812:Epidemiologic Methods; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000523:psychology*; D016584:Panic Disorder / Q000150:complications* / Q000401:mortality / Q000523:psychology; D055815:Young Adult